Splitface comparison of polynucleotides

MISS JENNIFER DOYLE

Miss Jennifer Doyle is a consultant oculoplastic surgeon based at The Clinic at Holland Park and at Milton Keynes University Hospital. She has a Bachelor’s in Medicine and a Bachelor’s in Surgery with distinction, as well as a Master’s in Medical Sciences from the University of Oxford.
Qual: BMBCh, MA(OXON), L7Cert, FRCOphth

Polynucleotides have had a recent increase in popularity due to patients searching for alternatives to the more traditional hyaluronic acid (HA)-based dermal filler injections. Polynucleotides provide four main bio-regeneration effects, including moisturising, biostimulation, detoxing against free radicals and a contouring and tightening effect.

The Ameela polynucleotide product contains high molecular weight polynucleotide chains, which have a biochemical effect. The product’s strong moisturising ability is a result of the water retention capabilities of the hydrophilic groups of the phosphorylated sugars of the single nucleotide. Polynucleotides connect with multiple cell receptors, initiating a cascade of reactions, most importantly attracting stem cells to the area, causing a strong repairing effect on the tissue. They also enhance the formation of new capillaries (angionesis) and stimulate changes to the structure of the fibrilles in our tissue which result in instant tightening and contouring of the tissue. The polymeric macromolecules have a scavenger action against free radicals. Polynucleotides have an ability to react immediately with free radicals, neutralising them.

Soft tissue HA filler injection is the second most common, minimally invasive procedure performed (second to botulinum toxin) and a substantial percentage of these procedures are treating the lower eyelid-cheek interface. By using HA, you achieve volume augmentation of the tear trough area, which can correct tear trough deformity. This is often best done by also treating the mid-face to provide structural support, as it can reduce the amount that is required to be injected to the tear trough itself. Most studies suggest that limiting the volume of filler to conservative amounts (0.3ml to each side) reduces the risk of complication to this difficult-to-treat area. The most common complications reported from a large case series of 1,545 people published in 2021 include oedema (up to 24%), bruising (up to 19%), contour irregularities (up to 8%) and the Tyndall effect (up to 6%). The risk of complications increases significantly with volumes above about 0.3 ml per side.

Due to the potential for complications with HA fillers in the delicate tear trough region, alternative treatments that can address concerns such as dark circles, hollowing and fine lines and wrinkles in this area are in high demand.

To highlight the impact that polynucleotides can have on this delicate area, I selected a patient who was willing to be treated unilaterally to create a split-face comparison to baseline allowing us to demonstrate the effect of the polynucleotide injection.

The patient is a 54-year-old female whose tear trough area demonstrated many commonly encountered concerns, such as dark circles with haemosiderin deposition, crepeyness, thinning of the skin and some hollowing.

METHOD

I treated the patient’s right tear trough region on two occasions, two weeks apart. For her first session, I started with Ameela Eyes, which was applied subdermally using a 25g cannula. I find treating the area with a cannula results in minimal patient discomfort and also improves safety. On review at two weeks, the patient reported that she had encountered minimal swelling and that any initial swelling had subsided within 24 hours. As a result, I felt confident to increase the strength of the second treatment to Ameela Rejuvenation. This was applied using the same technique and the patient was warned that, due to the increased viscosity and concentration of the product, she may encounter slightly more swelling than the first treatment.

Many of the biostimulatory effects of Ameela including angiogenesis take 30-60 days to develop. I therefore followed the patient up six weeks following her second treatment to review the effect of the product on the treated side. After this review the patient was treated on the left side to achieve balance.

RESULTS

As you can see from the photograph, after six weeks there was a vast improvement in the dark circle and hollowing seen on the treated side. The skin quality was much improved also, with increased elasticity of the tissues in the treated area.

CONCLUSION

This split-face unilateral treatment with Ameela to the tear trough area demonstrates the effect it can have in improving the quality of the tissues in the area, successfully addressing concerns such as dark circles and hollowing. The image was taken six weeks after the second treatment, showcasing the impressive biostimulatory effect that the product had on the tissues.

Polynucleotides provide a viable alternative to traditional HA fillers for rejuvenation of the tear trough region. As they are not a typical volumiser that stays within the tissues, the risks of prolonged oedema or contour irregularity are much less and this appeals to both practitioners and patients alike.

The stimulatory effect can take 30-60 days to settle in and generally two to three treatments are required, spaced two to four weeks apart. Placement of the product is best achieved with a 25g cannula to minimise downtime and improve safety.